Abortion, second-trimester

In human medicine, prostaglandin p2a is used for the induction of therapeutic and elective abortions, and for the induction of labour, either alone or in conjunction with other drugs such as oxytocin. Abortion with prostaglandins may involve relatively late abortion (second trimester to early third trimester). They are used for similar purposes in animal... 

Do not start the patch any earlier than 4 weeks after a second trimester abortion or miscarriage. When the patch is used postpartum or postabortion, the increased risk of thromboembolic disease must be considered. 

Abortifacient Intra-amniotic administration of PGF produced abortion with less severe adverse effects. It is used to induce second trimester abortion usually administered as a single 40 mg in-traamniotic injection. 

F. Role in therapy According to Micromedex, oxytocin is routinely used for the induction of labor at term and postpartum for the control of uterine bleeding. Oxytocin is not the drug of choice for induction of labor for abortion. Oxytocin infusion has been used following prostaglandin or hypertonic abortifacients to shorten the induction to abortion time when inducing second-trimester abortion, inducing abortion when a patient has failed to respond to the abortifacient, or to induce abortion after membranes have ruptured. 

Dinoprostone, a synthetic preparation of PGE2, is administered vaginally for oxytocic use. In the USA, it is approved for inducing abortion in the second trimester of pregnancy, for missed abortion, for benign hydatidiform mole, and for ripening of the cervix for induction of labor in patients at or near term. 

Oxytocin is used to induce labor for conditions requiring early vaginal delivery such as Rh problems, maternal diabetes, preeclampsia, or ruptured membranes. It is also used to augment abnormal labor that is protracted or displays an arrest disorder. Oxytocin has several uses in the immediate postpartum period, including the control of uterine hemorrhage after vaginal or cesarean delivery. It is sometimes used during second-trimester abortions. 

First- and second-trimester abortion Cervical reopening Induction of labor Augmentation of labor Postpartum hemorrhage Ectopic pregnancy Lactation suppression In gastrointestinal disease Peptic ulceration Liver transplantation Chemotherapy-induced mucosal lesions In cardiovascular disease Congenital cardiac malformations Raynaud s syndrome Chronic obstructive pulmonary disease Adult respiratory distress syndrome Pulmonary hypertension Arterial occlusive disease Extracorporeal circulation In urology Erectile dysfunction... 

Vaginal misoprostol is more effective and better tolerated than oral misoprostol for induction of first and second trimester abortions after the administration of mifepristone (1,2). It is more effective than either gemeprost or sulprostone combined with mifepristone for induction of first trimester abortion, although uterine rupture has been reported (3). 

Several cases of uterine rupture due to misoprostol after second trimester have been reported. However, unexpectedly, administration of misoprostol for cervical ripening before surgical evacuation of a missed abortion reportedly produced uterine rupture in the first trimester... 

Jain JK, Mishell DR Jr. A comparison of misoprostol with and without laminaria tents for induction of second-trimester abortion. Am J Obstet Gynecol 1996 175(1) 173—7. 

Al-Hussaini TK. Uterine rupture in second trimester abortion in a grand multiparous woman. A complication of misoprostol and oxytocin. Eur J Obstet Gynecol Reprod Biol 2001 96(2) 218-9. 

Ranjan V, Hingorani V, Kinra G, Agarwal N, Pande Y. Evaluation of sulprostone for second trimester abortions and its effects on liver and kidney function. Contraception 1982 25(2) 175-84. 

Corrado F, D Anna R, Cannata ML. Rupture of the cervix in a sulprostone induced abortion in the second trimester. Arch Gynecol Obstet 2000 264(3) 162-3. 

PGF2 is available for clinical gynecologic use. This drug, carboprost tromethamine (15-methyl-PGF2ct the 15-methyl group prolongs the duration of action) was withdrawn from the United States market. Carboprost is used to induce second-trimester abortions and is usually administered as a single 2.5 mg intra-amniotic injection. The abortion is normally completed in less than 20 hours. 

Prostaglandin E2 (PGE2) is an agent used to ripen the cervix for the induction of labor (it is also used for second-trimester abortion) and shows various beneficial effects ... 

Jackson RA, Teplin VL, Drey EA, Thomas LJ, Darney PD. Digoxin to facilitate late second-trimester abortion a randomized, masked, placebo-controlled trial. Obstet Gynecol 2001 97(3) 471-6. 

Drey EA, Thomas LJ, Benowitz NL, Goldschlager N, Darney PD. Safety of intra-amniotic digoxin administration before late second-trimester abortion by dilation and evacuation. Am J Obstet Gynecol 2000 182(5) 1063-6. 

Uterine rupture has also been associated with misoprostol (200 micrograms vaginaUy) dnring second trimester termination of pregnancy. Occasionally, nterine mptnre can occur in women who have not had a previons cesarean section, as happened in two women, one of whom had a normal delivery and the other cnrettage after abortion (23). 

First- and second-trimester abortion Cervical reopening Induction of labor Augmentation of labor Postpartum hemorrhage Ectopic pregnancy Lactation suppression... 

The acridinyl aniside amascrine (165) is useful in treatment of some cancers, including acute adult leukemia. The lactate of 7-ethoxy-3,9-acridine diamine, or ethacridine (166), is an abortifacient, used for induction of second trimester abortions. The antitumor drug mitozantrone (mitoxantrone, novantrone) (167), a bis(hydroxy)aminoanthraquinone... 

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